Intake Coordinator

Orca, ADN, ASN, RN · May 12, 2009

Part of that depends upon whether you are going to be at a freestanding mental health facility or a unit in a general hospital. If the facility is freestanding, be sure that the people you admit are medically stable - as a general rule, no tubes or lines running into or out of them and no continuous O2. The only patient I had die under my care in mental health was admitted to my unit (freestanding mental health facility, geropsych unit) without enough questions being asked.

This man, in his early 50s, had a multitude of medical problems. He was a patient in a hospital 100 miles away, so our intake person did a telephone assessment. He had told the people at the hospital "I don't want to live like this", which they interpreted as suicidal ideation and called us. The man was physically incapable of killing himself (he got winded sitting up in bed), and his desire to die was perfectly understandable under the circumstances. Hospital personnel failed to make the very important distinction between not wanting to continue living in a deteriorating state and actively planning to commit suicide, and our intake people didn't pick up on this either. He came in on four liters of continuous O2, which told me immediately that depression wasn't his most pressing issue.

I was working with a CNA the morning he was admitted (he came in on the night shift, I was the day RN). I did my morning rounds and started pouring my AM meds when there was a knock on the med room door. The CNA said "I don't think this man is breathing." Sure enough, full respiratory and cardiac arrest. The man was a DNR, which our intake people neither asked about nor obtained from the hospital - I only found this out hours after running a full code on a man who was dead when I entered the room. Intake also had not confirmed the contact information for the family. The telephone number was wrong, and it took more than a week to reach the man's family after his passing.

The moral of the story - make sure your intake people ask enough questions, and the right ones, before agreeing to admit anyone. You should also be wary of hospitals with mental health units calling to ask about available beds. They could just be full, but they may also be trying to dump people with no insurance, people who will be post-treatment placement problems or people they have had trouble with before. If your facility takes involuntary admissions, make sure that the sending facility sends the original documentation properly filled out and signed. I used to check the documents before the patient ever went onto the unit, and I had to send some patients back because the commitment form wasn't complete.

Thunderwolf, MSN, RN · May 16, 2009

The moral of the story - make sure your intake people ask enough questions, and the right ones, before agreeing to admit anyone. You should also be wary of hospitals with mental health units calling to ask about available beds. They could just be full, but they may also be trying to dump people with no insurance, people who will be post-treatment placement problems or people they have had trouble with before. If your facility takes involuntary admissions, make sure that the sending facility sends the original documentation properly filled out and signed. I used to check the documents before the patient ever went onto the unit, and I had to send some patients back because the commitment form wasn't complete.

This cannot be overemphasized.

Totally agree.

Thanks, Orca.

Jules A, MSN · May 16, 2009

thank you for inquiring. sadly it seems like we are often at odds with intake when we should be working together. definitely make sure they are medically stable. ask about neighboring hospitals and their mo. you will find some are very pushy. we have one that if we aren't firm will load the patient in an ambu without even having prior auth or giving report. one of our biggest problems is patients coming from our own med-surge units. they just don't seem to be willing to deal with psych pts. i've had to refuse quite a few, like a 24 hour post op self-inflicted gunshot wound. if for example they are violent or severely agitated please make sure they have been medicated! you may laugh but i can't count the number of times our intake tries to send someone up to us that is in 4 point restraints due to violent behavior and yet no prn medications have been given. they act like i'm trying to avoid getting an admission when the truth is i have other patient's safety to consider. like everywhere we are almost always short staffed so i can't afford to have a raging patient brought in the front door if it can been avoided. congratulations and good luck with your new job!

Orca, ADN, ASN, RN · May 16, 2009

One of our biggest problems is patients coming from our own med-surge units. They just don't seem to be willing to deal with psych pts.

Excellent point. When I worked on a hospital-based unit, we had a patient sent to us from the tele floor where he had been running all over the unit. They sent him to our unit in a wheelchair, and told us he had "bumped into something." As soon as I saw this man I knew something was wrong. He had a multiple fracture of the left shoulder, and they didn't even do x-rays. I had the x-rays ordered after he arrived on the floor, and sent him to surgery about two hours later.

Another admission I got from our ER. The guy tried to kill himself by driving his car into a tree. I guess the ER doc stopped the intake physical when the guy told him what happened, and immediately sent him to us. He was wearing a gown with a blanket draped over him. He complained of his ankles hurting. When I lifted the blanket I saw that both of his ankles were purple and swelled like grapefruits. When I called the ER doc to ask him if they did x-rays, his attitude was "How dare you question my assessment." I got the psychiatrist to order bilateral ankle x-rays, and both of the patient's ankles were shattered. We sent him to surgery the next morning.